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Men may seek alternatives to vasectomy reversal when their attempt at having their vasectomy reversed via surgery has failed or they choose not to undergo a vasectomy reversal but still want to father a child. Up to 10% of men who have a vasectomy eventually decide they want to have a child, and some of them are looking for alternatives to vasectomy reversal. Fortunately, there are several options.
When vasectomy reversal fails
If tests show there are no sperm in a man’s semen by six months after vasovasostomy or by 12 to 18 months after epididymovasostomy, then the vasectomy reversal surgery is considered to have failed. The failure could have been due to the need for an epididymovasostomy rather than the vasovasostomy that was performed the first time. A vasovasostomy may also fail because scarring develops that blocks sperm.
Repeat vasectomy reversal
One of the alternatives to vasectomy reversal failure is, ironically, to repeat the vasectomy reversal surgery. The success rates of repeat vasectomy reversals are lower than those after an initial attempt. One study has shown an 86% success rate for first vasectomy reversals compared with 75% for a repeat vasectomy reversal. The accompanying successful rates of pregnancy were 52% and 43%, respectively.
Alternatives to vasectomy reversal: ART
ART, or assisted reproductive technology, is one of the alternatives to vasectomy reversal. It includes several treatment methods that can be used when a couple’s infertility is caused by factors other than a man having had a vasectomy. ART methods are generally more complicated and more costly than a vasectomy reversal.
All methods and variations of ART involve some form of combining sperm and eggs to treat infertility and achieve pregnancy. For ART to have a chance at being successful, both the sperm and the eggs must be healthy. Men who have banked sperm can use it for ART. Ejaculated sperm can be used for artificial insemination, while sperm that is retrieved from the testicles or epididymis can be used only with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) (see below).
Sperm for assisted reproductive technologies
Sperm can be retrieved via a surgical incision or through a needle. The surgical techniques for sperm retrieval include the following:
- Microsurgical Epididymal Sperm Aspiration (MESA): A surgeon makes an incision in the scrotum and uses optical magnification to cut the epididymal tubules and aspirate sperm-rich fluid. The fluid can be used for intracytoplasmic injection immediately or frozen for IVF-ICSI.
- Percutaneous Epididymal Sperm Aspiration (PESA): A doctor inserts a needle via the scrotum into the epididymis to aspirate sperm. This method does not always yield sperm.
- Testicular Sperm Extraction (TESE): A surgeon makes a tiny incision in the scrotum and extracts a tissue sample from the testicle. Sperm is then extracted from the sample and can be used immediately for IVF-ICSI or frozen for later use.
- Testicular Sperm Aspiration (TESA): A needle is passed through the scrotum into the testicle, and a small amount of testicular tissue is aspirated. Because the sample is small, there is typically only enough sperm for one attempt at IVF-ICSI.
- Testicular Perc-Biopsy. This technique is similar to TESA. The needle is part of an instrument known as a “biopsy gun” and larger and so the sample is bigger.
Eggs for assisted reproductive technologies
There are several ways to prepare a woman’s eggs for fertilization. In each case, a woman’s eggs are retrieved using a laparoscope, which requires a small incision.
- In Vitro Fertilization (IVF): The retrieved eggs are mixed with sperm and allowed to fertilize in a lab. If fertilization occurs, the fertilized egg is placed in the woman’s uterus. IVF may also utilize intracytoplasmic sperm injection (ICSI; see below). Low fertilization rates (about 15%) are achieved other than with ejaculated sperm (50%-70%); hence the need for ICSI.
- Intracytoplasmic Sperm Injection (ICSI): A woman’s retrieved eggs are injected with one sperm per egg. If an embryo results in the lab, 1 to 3 are returned to the uterus (IVF) and the remainder are frozen for later use.
All of the ART procedures are done on an outpatient basis and can involve the use of local or localized sedation. Procedures that involve an incision should be followed by 48 hours of very limited physical activity and one week without sexual activity or exercise. The man’s recovery from procedures that involve needle aspiration (PESA, TESA, Testicular Perc-Biopsy) requires only several days of limited activity.
Risks associated with retrieval methods
Alternatives to vasectomy reversal are not without risks. The risks associated with the various sperm retrieval methods include bleeding, infection, and (rarely) permanent damage to the testicle, which leads to shrinkage. Procedures such as MESA and PESA may scar the epididymis and make it impossible to perform a subsequent vasectomy reversal on that side.
Cost of assisted reproductive technology
The cost of sperm retrieval can range from $3,500 to $7,500 or higher per retrieval. In addition, ART costs range from $10,000 to $15,000 or higher per attempt. Based on the costs and risks associated with ART for both men and women, the American Society for Reproductive Medicine suggests in situations in which men have had a vasectomy and their partner has no known infertility risk factors, a vasectomy reversal is recommended rather than sperm retrieval with IVF-ICSI. However, ART is still one of the alternatives to vasectomy reversal.